Schizophrenia

(Psychosis, Psychotic Disorders)

The Facts

Schizophrenia is a serious and chronic medical condition. It is a disorder of the message system in the brain. Someone with schizophrenia loses the ability to act properly or to think clearly–their mind is "split from reality" (hence schizo "split" and phrenia "mind" from ancient Greek). The term schizophrenia does not refer to multiple personality disorder.

Schizophrenia affects about 1% of people throughout the world. It sometimes starts during childhood, but most often shows up in the late teens or 20s. While it affects men and women proportionately, the average age of onset is somewhat lower in men.

It can develop gradually, over the course of weeks or months, or it can seem to come on very suddenly. The signs of schizophrenia are easy to misunderstand, and can sometimes be frightening to other people. While this disorder never goes away, it can often be managed with proper medical care and family support.

The Causes

We do not yet know what causes schizophrenia. There are many theories, but it is most likely a result of genetic factors that trigger complex changes in the brain's chemistry and structure. Research has demonstrated that people with schizophrenia have changes in brain function and anatomy. However, it's not clear whether schizophrenia is a single disorder or a number of "syndromes" with different causes.

Some experts believe that the condition is triggered by stressors (e.g., substance misuse, stressful life events) in people whose brains are predisposed.

Symptoms And Complications

Schizophrenia can have a gradual or sudden onset. But for most people, mild symptoms are followed by more severe ones. Symptoms of schizophrenia can vary widely in severity, can come and go, or be persistent. For those who experience mild symptoms initially, the first signs may be withdrawal from friends or social activities, poor school performance, caring less about personal appearance, and perceiving things differently.

The symptoms of schizophrenia usually fall into one of several groups:

Positive symptoms are symptoms associated with excess or distortion of normal function. Positive symptoms include delusions, hallucinations, and disorganized thoughts and behaviours.
- Delusions are false beliefs (e.g., being followed, reading or watching something and thinking the message is directed at them personally, thinking people can read their mind or control their thoughts).
- Hallucinations are hearing, seeing, feeling, smelling, or tasting things that are not actually there.Hearing voices (auditory) is the most common type of hallucinations with schizophrenia.
- Disorganized thinking can result in switching topics quickly when talking or not making sense when talking. Disorganization can also cause inappropriate behaviour (e.g., agitation, poor hygiene, and disturbances in feelings (e.g., may feel devoid of emotion, or may experience sudden, inappropriate bursts of feeling, or may find it difficult to express feelings).
Negative symptoms refer to a decrease or loss of normal function. This can include lack of eye contact, lack of emotional response, decreased talking, decreased pleasure, reduced motivation, and decreased interest in social activities and relationships. They may find it difficult to carry out daily activities such as going to work or shopping.
Cognitive impairment can include difficulties with concentration, attention, learning, problem solving, and problems with memory.

Emotional and mood symptoms such as anxiety, depression or inappropriate behaviour can also occur with schizophrenia.

Some people may present with physical symptoms, including sleep disturbances and catatonia (impaired, excessive, or unusual mobility). It is also associated with diabetes, high blood pressure, and high cholesterol.

During the acute phase of the disease, psychotic symptoms get worse and influence the ability to function normally. Stabilization refers to a period when symptoms are being treated and controlled by medications. There may not be any obvious psychotic symptoms during this phase, but some people still have problems coping with day-to-day situations.

About 5% of people with schizophrenia commit suicide, and around 20% have made an attempt. People most at risk for suicide are those who have paranoid schizophrenia, especially if they were functioning well prior to having schizophrenia. This high suicide rate partially explains the 10-year reduction in expected lifespan for those with the disorder.

Making A Diagnosis

No diagnostic test exists for schizophrenia. Instead, the disease is identified (usually by a psychiatrist) by the symptoms. This specialist will ask a person about their ability to work, socialize, or function. Family and friends might also be called upon to answer questions about the person's behaviour.

Your doctor (usually a psychiatrist) will diagnose schizophrenia if your symptoms meet the criteria (based on experiencing certain symptoms for a certain period of time) for a diagnosis. Other possible causes for the symptoms must be ruled out. Psychosis-like behaviour can occur with mood disorders, some neurological diseases (e.g., brain tumours), some metabolic or autoimmune diseases, Huntington's disease, liver disease, or reactions to particular medications. Substance abuse can also be responsible for certain behaviours that are similar to the symptoms of schizophrenia.

To investigate further, a doctor might perform computed tomography (CT) or magnetic resonance imaging(MRI) scans. These create detailed images of the brain and can be used to exclude diseases other than schizophrenia. While not diagnostic, CT and MRI changes do occur in some people with schizophrenia.

Treatment And Prevention

Schizophrenia cannot be prevented, since we do not yet understand what causes it. There is no cure, but antipsychotic medications, psychotherapy, rehabilitation, and support from family and friends can help to treat the symptoms.

It is very important that medications are taken correctly and regularly, according to your doctor's instructions. Taking medication regularly can be difficult for people with schizophrenia, either because of side effects or from the symptoms of the condition getting in the way. If you have trouble taking your medications, talk to your doctor or pharmacist to see what can be done to help (e.g., change medications).

Antipsychotic medications can control delusions, hallucinations, and disorganized thinking. These can greatly lower the chances of further psychotic episodes. Although most people respond well to first-generation medications (e.g., haloperidol*, fluphenazine), due to the side effects of these medications (e.g., drowsiness, tremors muscle stiffness, weight gain), schizophrenia is often treated with "atypical" or second-generation antipsychotic medications (e.g., olanzapine, risperidone, ziprasidone, quetiapine, aripiprazole, clozapine).

With any therapy, the dose a person is started on might need adjustment in order to find a good balance between the treatment and the side effects. Your doctor will discuss the risk and benefits of the medications available to treat schizophrenia, and together you will decide on the best treatment for you. Other medications can also be prescribed to help reduce the side effects of antipsychotic medications.

In all instances, a doctor will monitor for side effects and will ensure the medication is working.

People being treated for schizophrenia require more than just medications. They also need counselling to be coached on coping with the stresses of daily life, since these can aggravate symptoms or cause a relapse. Health care professionals are on hand to help people learn to take care of themselves. They can advise those living with schizophrenia on how to have better relationships with the people around them and on how to hold onto a job. These are all skills that must be learned, since the illness has kept many of those affected from participating in activities others take for granted. Rehabilitation and psychotherapy provide assistance that allow people with schizophrenia to live independently.

Along with appropriate medical treatment, having a good support network of friends and family can make a difference in dealing with schizophrenia, and make inroads towards leading a full, productive life. It is important that family members become informed and educated about the condition so that they can be advocates for their loved ones. For more information, consult your community mental health agencies, local chapters of the Schizophrenia Society of Canada, or the Canadian Mental Health Association.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.